Distribution and correlates of waist-to-hip ratio in black adults: the Pitt County Study

Identifying the Characteristics of Responders and Nonresponders in a Behavioral Intervention to Increase Physical Activity Among Patients With Moderate to Severe Asthma: Protocol for a Prospective Pragmatic Study

BACKGROUND

Previous research has suggested that most adults improve their asthma control after a short-term behavioral intervention program to increase physical activity in daily life (PADL). However, the characteristics of individuals who respond and do not respond to this intervention and the medium-term response remain unknown.

OBJECTIVE

This study aims to (1) identify the characteristics of adult responders and nonresponders with asthma to a behavioral intervention to increase physical activity and (2) evaluate the functional and clinical benefits in the medium term.

METHODS

This prospective pragmatic study will include adults with moderate to severe asthma who enroll in a behavioral intervention. All individuals will receive an educational program and an 8-week intervention to increase PADL (1 time/wk; up to 90 min/session). The educational program will be conducted in a class setting through group discussions and video presentations. Behavioral interventions will be based on the transtheoretical model using counseling, incentives, and individual feedback aiming to increase participation in physical activity. Motivational interviewing and guidelines for overcoming barriers will be used to stimulate individuals to reach their goals. Pre- and postintervention assessments will include the following: PADL (triaxial accelerometry), body composition (octopolar bioimpedance), barriers to PADL (questionnaire), clinical asthma control (Asthma Control Questionnaire), quality of life (Asthma Quality of Life Questionnaire), anxiety and depression levels (Hospital Anxiety and Depression Scale), and exacerbations. "Responders" to the intervention will be defined as those who demonstrate an increase in the number of daily steps (≥2500).

RESULTS

In December 2021, the clinical trial registration was approved. Recruitment and data collection for the trial is ongoing, and the results of this study are likely to be published in late 2024.

CONCLUSIONS

The intervention will likely promote different effects according to the clinical characteristics of the individuals, including asthma control, age, anxiety and depression levels, obesity, and several comorbidities. Identifying individuals who respond or do not respond to behavioral interventions to increase PADL will help clinicians prescribe specific interventions to adults with asthma.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05159076; https://clinicaltrials.gov/ct2/show/NCT05159076.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/49032.

Prevalence and Predictors of Combined Body Mass Index and Waist Circumference Among Indian Adults

Objective: To determine the prevalence and predictors of combined BMI-WC disease risk categories among Indian adults.

Methods: The study utilizes data from Longitudinal Ageing Study in India (LASI Wave 1) with an eligible sample of 66, 859 individuals. Bivariate analysis was done to get the proportion of individuals in different BMI-WC risk categories. Multinomial logistic regression was used to identify the predictors of BMI-WC risk categories.

Results: Poor self-rated health, female sex, urban place of residence, higher educational status, increasing MPCE quintile, and cardio-vascular disease increased with increasing BMI-WC disease risk level while increasing age, tobacco consumption, and engagement in physical activities was negatively associated with BMI-WC disease risk.

Conclusion: Elderly persons in India have a considerable higher prevalence of BMI-WC disease risk categories which make them vulnerable to developing several disease. Findings emphasize the need of using combined BMI categories and waist circumference to assess the prevalence of obesity and associated disease risk. Finally, we recommend that intervention programs with an emphasis on urbanites wealthy women and those with a higher BMI-WC risk categories be implemented.

A Behavior Change Intervention Aimed at Increasing Physical Activity Improves Clinical Control in Adults With Asthma: A Randomized Controlled Trial

BACKGROUND

Higher levels of physical activity have been associated with better asthma clinical control.

RESEARCH QUESTION

Does a behavior change intervention aimed at increasing physical activity change asthma clinical control, physical activity, sedentary time, health-related quality of life (HRQoL), and anxiety and depression symptoms?

STUDY DESIGN AND METHODS

This single-blind, randomized controlled trial included participants who were allocated to an intervention group (IG) or to a control group (CG). Both groups received usual care and disease-specific education. Participants in the IG also underwent an 8-week behavior change intervention aimed at increasing physical activity. Prior to and following the intervention period, measures were made of asthma clinical control (Asthma Control Questionnaire [ACQ]), physical activity, sedentary time and sleep quality (ActiGraph), HRQoL (Asthma Quality of Life Questionnaire), and anxiety and depression symptoms (Hospital Anxiety and Depression Scale). Data on asthma exacerbations were recorded 12 months prior to and throughout the intervention period.

RESULTS

Fifty-one participants were included (CG, n = 26; IG, n = 25). On completion of the intervention period, compared with the CG, those in the IG exhibited improvements in asthma control (mean difference [95% CI] in ACQ score, -0.8 [-1.1 to -0.4]); in daily step count, 3,605 [1,937 to 8,867] steps/d; in sleep efficiency, 9.2% [-7.1% to 21.9%]; and a reduction in sedentary time, -1.1 [-2.9 to -0.6] h/d). No between-group difference in HRQoL was observed. The percentage of participants who experienced exacerbations during the intervention period was 27% in the IG vs 60% in the CG (P = .04). The change in time spent in moderate-intensity physical activity was inversely associated with change in ACQ (r = -0.60). Compared with the CG, a higher percentage of participants in the IG reported a reduction in anxiety symptoms (43% vs 0%; P < .02).

INTERPRETATION

In adults with moderate to severe asthma, a comprehensive behavior change intervention that increased physical activity also produced improvements in asthma clinical control, sedentary time, sleep quality, and anxiety symptoms.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov; No.: NCT03705702; URL: www.clinicaltrials.gov.

Effects of a behaviour change intervention aimed at increasing physical activity on clinical control of adults with asthma: study protocol for a randomised controlled trial

Background

In adults with asthma, physical activity has been associated with several asthma outcomes. However, it is unclear whether changes in physical activity, measured via an accelerometer, have an effect on asthma control. The objective of the present study is, in adults with moderate-to-severe asthma, to investigate the effects of a behaviour change intervention, which aims to increase participation in physical activity, on asthma clinical control.

Methods

This is a single-blind (outcome assessor), two-arm, randomised controlled trial (RCT). Fifty-five participants with moderate-to-severe asthma, receiving optimized pharmacological treatment, will be randomly assigned (computer-generated) into either a Control Group (CG) or an Intervention Group (IG). Both groups will receive usual care (pharmacological treatment) and similar educational programmes. In addition to these, participants in the IG will undergo the behaviour change intervention based on feedback, which aims to increase participation in physical activity. This intervention will be delivered over eight sessions as weekly one-on-one, face-to-face 40-min consultations. Both before and following the completion of the intervention period, data will be collected on asthma clinical control, levels of physical activity, health-related quality of life, asthma exacerbation and levels of anxiety and depression symptoms. Anthropometric measurements will also be collected. Information on comorbidities, lung function and the use of asthma medications will be extracted from the participant’s medical records.

Discussion

If successful, this study will demonstrate that, in adults with asthma, a behavioural change intervention which aims to increase participation in physical activity also affects asthma control.

Trial registration

Clinical Trials.gov PRS (Protocol registration and Results System): NCT-03705702 (04/10/2018).

Dynamic hyperinflation and exercise limitations in obese asthmatic women

Obese individuals and patients with asthma can develop dynamic hyperinflation (DH) during exercise; however, no previous study has investigated DH as a factor associated with reduced exercise capacity in obese asthmatic women. The aim of the present study was to examine the occurrence of DH and exercise limitations in obese asthmatics. Obese grade II [obese group (Ob-G); BMI 35-39.9 kg/m²; n=36] and nonobese [nonobese group (NOb-G); BMI 18.5-29.9 kg/m²; n=18] asthmatic patients performed a cardiopulmonary test to quantify peak V̇o₂ and a submaximal exercise test to assess DH. Anthropometric measurements, quadriceps endurance, and lung function were also evaluated. A forward stepwise regression was used to evaluate the association between exercise tolerance (wattage) and limiting exercise factors. Fifty-four patients completed the protocol. The Ob-G (n = 36) presented higher peak V̇o₂ values but lower power-to-weight ratio values than the NOb-G (P <0 .05). DH was more common in the Ob-G (72.2%) than in the NOb-G (38.9%, P < 0.05). The Ob-G had a greater reduction in the inspiratory capacity (-18 vs. -4.6%, P < 0.05). Exercise tolerance was associated with quadriceps endurance (r = 0.65; p<0.001), oxygen pulse (r = 0.52; p=0.001), and DH (r = -0.46, P = 0.005). The multiple regression analysis showed that the exercise tolerance could be predicted from a linear association only for muscular endurance (r = 0.82 and r² = 0.67). This study shows that dynamic hyperinflation is a common condition in obese asthmatics; they have reduced fitness for activities of daily living compared to nonobese asthmatics. However, peripheral limitation was the main factor associated with reduced capacity of exercise in these patients.NEW & NOTEWORTHY This is the first study to investigate the occurrence of dynamic hyperinflation (DH) in obese asthmatics. Our results demonstrate that obese asthmatics present a higher frequency and intensity of DH than nonobese asthmatics. We also show that physical deconditioning in this population is linearly associated with cardiac (O₂ pulse), respiratory (DH), and peripheral muscle (resistance) limitation. However, multiple linear regression demonstrated that peripheral muscle limitation may explain the exercise limitation in this population.

The Role of Exercise in a Weight-Loss Program on Clinical Control in Obese Adults with Asthma. A Randomized Controlled Trial

RATIONALE

Clinical control is difficult to achieve in obese patients with asthma. Bariatric surgery has been recommended for weight loss and to improve asthma control; however, the benefits of nonsurgical interventions have been poorly investigated.

OBJECTIVES

To examine the effect of exercise training in a weight-loss program on asthma control, quality of life, inflammatory biomarkers, and lung function.

METHODS

Fifty-five obese patients with asthma were randomly assigned to either a weight-loss program plus exercise (WL + E group, n = 28) or a weight-loss program plus sham (WL + S group, n = 27), where the weight-loss program included nutrition (caloric restriction) and psychological therapies. The WL + E group incorporated aerobic and resistance muscle training, whereas the WL + S group incorporated breathing and stretching exercises.

MEASUREMENTS AND MAIN RESULTS

The primary outcome was clinical improvement in asthma control over 3 months. Secondary outcomes included quality of life, lung function, body composition, aerobic capacity, muscle strength, and inflammatory/antiinflammatory biomarkers. After 3 months, 51 patients were analyzed. Compared with the WL + S group, the WL + E group demonstrated improved clinical control scores (median [25th to 75th percentile], -0.7 [-1.3 to -0.3] vs. -0.3 [-0.9 to 0.4]; P = 0.01) and greater weight loss (mean ± SD, -6.8% ± 3.5 vs. -3.1% ± 2.6; P < 0.001) and aerobic capacity (median [25th to 75th percentile], 3.0 [2.4 to 4.0] vs. 0.9 [-0.3 to 1.3] ml O₂ × kg^-1 × min^-1; P < 0.001). These improvements in the WL + E group were also accompanied by improvements in lung function, antiinflammatory biomarkers, and vitamin D levels, as well as reductions in airway and systemic inflammation.

CONCLUSIONS

Adding exercise to a short-term weight-loss program should be considered as a useful strategy for achieving clinical control of asthma in obese patients. Clinical trial registered with www.clinicaltrials.gov (NCT 02188940).

The effects of exercise training in a weight loss lifestyle intervention on asthma control, quality of life and psychosocial symptoms in adult obese asthmatics: protocol of a randomized controlled trial

BACKGROUND

Asthma and obesity are public health problems with increasing prevalence worldwide. Clinical and epidemiologic studies have demonstrated that obese asthmatics have worse clinical control and health related quality of life (HRQL) despite an optimized medical treatment. Bariatric surgery is successful to weight-loss and improves asthma control; however, the benefits of nonsurgical interventions remain unknown.

METHODS/DESIGN

This is a randomized controlled trial with 2-arms parallel. Fifty-five moderate or severe asthmatics with grade II obesity (BMI ≥ 35 kg/m(2)) under optimized medication will be randomly assigned into either weight-loss program + sham (WL + S group) or weight-loss program + exercise (WL + E group). The weight loss program will be the same for both groups including nutrition and psychological therapies (every 15 days, total of 6 sessions, 60 min each). Exercise program will include aerobic and resistance muscle training while sham treatment will include a breathing and stretching program (both programs twice a week, 3 months, 60 min each session). The primary outcome variable will be asthma clinical control. Secondary outcomes include HRQL, levels of depression and anxiety, lung function, daily life physical activity, body composition, maximal aerobic capacity, strength muscle and sleep disorders. Potential mechanism (changes in lung mechanical and airway/systemic inflammation) will also be examined to explain the benefits in both groups.

DISCUSSION

This study will bring a significant contribution to the literature evaluating the effects of exercise conditioning in a weight loss intervention in obese asthmatics as well as will evaluate possible involved mechanisms.

TRIAL REGISTRATION

NCT02188940.

Obesity in Minority Populations: An Epidemiologic Assessment

This article reviews issues relating to the prevalence, health implications, and prevention and treatment perspectives of obesity in U.S racial and ethnic minority groups. The growing interest in obesity in minority populations reflects an awareness of the high prevalence of obesity among black, Hispanic, Asian and Pacific Islander and Native Americans as well as a generally increased interest in minority health. In addition, the fact that some aspects of obesity among minorities differ from those in whites suggests that new insights may be gained from studying obesity in diverse populations. However, there are many methodological problems to be overcome, including some that arise from the way minority groups are defined. Under the assumption that all obesity results from a period of sustained positive energy balance at the individual level, an epidemiologic explanation for the excess of obesity in minorities at the population level seems readily apparent. A surplus of obesity-promoting forces and a deficit of obesity-inhibiting forces, caused by secular changes in food availability and physical activity, accompany the early phases of modernization and economic advancement. The high prevalence of obesity in minority populations can be viewed as a function of the slope and timing of these secular changes. Genetic predisposition, cultural attitudes, and exposure to maternal obesity and diabetes in utero may be potentiating factors. In this context, interventions targeting individuals would seem inevitably to put racial and ethnic minority groups on the path toward the same weight control crisis now observed in the majority white population. This suggests that the underlying causes of the societal energy balance problem must be addressed at the population level in order for effective clinical approaches to be developed for minority populations with a high obesity prevalence.

Anthropometric indexes of obesity and hypertension in elderly from Cuba and Barbados

OBJECTIVE

To investigate the association between various anthropometric indexes of obesity with arterial hypertension in elderly from Barbados (Bridgetown) and Cuba (Havana).

DESIGN

Cross-sectional data were extracted from the Survey on Health, Aging and Well being in Latin America and the Caribbean (SABE).

SAMPLE SIZE

In Bridgetown and Havana, respectively, 1508 and 1905 subjects ( ≥ 60 years) were examined, and were selected by a controlled sampling design.

MEASUREMENTS

The occurrence of hypertension was assessed by self-report. Multiple measurements of adiposity were used including body mass index (BMI ≥ 28 kg/m(2)), waist hip ratio (WHR = > 0.95 men; > 0.80 women), waist to height ratio (W/ht. = > 0.50) and waist circumference - WC(L) ( > 88 cm, women; > 102 cm, men) e WC(OK) ( > 90.3 cm, women; > 91.3 cm, men). Binary logistic regression analyses (Odds Ratio) were used to measure strengths of relationships.

RESULTS

In the elderly of Bridgetown, the final design (adjusted for age, education, race, smoking, regular physical activity and diabetes) shows that, in men, WC(OK) and W/Ht were associated with hypertension, and in women, WCL and WCOK were the indexes associated. In the Cuban elderly, the final design shows that, with the exception of WHR, all indicators were associated with hypertension. WCOK and W/ht were the indexes most strongly associated with the outcome.

CONCLUSION

The explanatory power of anthropometric indicators when determining the outcome differed between men and women, as well as between cultural groups living in relative proximity (Barbadians and Cubans).

Association between Alcohol Intake and Abdominal Obesity among the Korean Population

OBJECTIVES

Although abdominal obesity has been reported to be highly related with alcohol intake, the results are still inconclusive. Therefore, this study was conducted to explore the association between alcohol and abdominal obesity among the Korean population.

METHODS

This study included 8,603 participants (men: 5,195, women: 3,408) aged 30 to 87 who visited the health promotion centers in Seoul for routine health examinations from April, 2006 to June, 2007. Abdominal obesity was defined as WC ≥90 cm for men and ≥85 cm for women in accordance with the Korean Society for the Study of Obesity. For ever drinkers, total alcohol consumption in grams was classified into four groups (group 1, non-drinkers; group 2, 1-10 g of alcohol per day; group 3, 11-20 g of alcohol per day; and group 4, over 20 g of alcohol per day).

RESULTS

The mean age of the study population was 45.4 yr old (men) and 45.3 yr (women). The average waist circumference was 85.3 cm in men and 75.3 cm in women. A high alcohol intake was associated with high waist circumference in both genders. In multivariate analysis, the group of men and women drinkers consuming >20 g in a day had a large waist circumference compared with men and women non-drinkers.

CONCLUSION

This study showed that a high alcohol intake was related to high waist circumference. Such association remained independently even after adjustment for smoking, which is strongly related to abdominal obesity.

Chronic energy deficiency in some low socio-economic populations from South India: Relationships between body mass index, waist–hip ratio and conicity index

This paper reports the prevalence of chronic energy deficiency (CED) based on body mass index (BMI) and its relation to other adiposity measures namely, waist-hip ratio (WHR) and conicity index (CI) in some low socio-economic groups from South India. Two ethnic groups from each area type, namely, tribal, rural and urban areas, are included and samples of 646 men and 670 women belonging to six groups are selected on a multistage basis. Based on the measurements, BMI, WHR and CI are calculated. A considerable proportion of populations studied here experience CED. A higher proportion of women than men show CED. The BMI and WHR are slightly higher among men and WHR exhibits significant intersex difference. The CI is in expected ranges and all ethnic groups differ from each other in all measurements and indices. Age is strongly correlated with WHR and CI, but not with BMI. Both WHR and CI are influenced by BMI. BMI and sex are found to be significant contributors to the variation in WHR, and ethnicity also added to the variation in CI. The present study also concludes that adult malnutrition (as indicated by BMI) is spread to a considerable extent in these populations of low socio-economic status. It appears that the ethnic differences occurring in several measurements/indices reflect the economic and social conditions.

Associations of abdominal fat with perceived racism and passive emotional responses to racism in African American women

OBJECTIVES

An excess in abdominal fat may predispose African American women to chronic health conditions such as diabetes and cardiovascular disease. Because stress may increase body fat in the center-body region, we used the waist-to-hip ratio (WHR) to examine associations between excess abdominal fat and perceived racism (a chronic stressor) and daily stress. Passive emotional responses to perceived racism, hypothesized to have particularly adverse effects, were also examined.

METHODS

We controlled for body mass index in multiple logistic regression models among 447 African American women who completed a telephone interview on perceived racism.

RESULTS

Passive emotional responses were not related to WHR (odds ratio [OR]=1.4; 95% confidence interval [CI]=0.8, 2.4). High perceived racism was associated with a low WHR in this population (OR=0.4; 95% CI=0.3, 0.8). However, high daily stress was related to a high WHR (OR=2.7; 95% CI=1.1, 6.7).

CONCLUSIONS

Findings support an association between daily stress and WHR but do not support our hypothesis that passive emotional responses to perceived racism increase abdominal fat. Further study of the stress physiology of perceived racism in African American women is warranted.

Alcohol intake in relation to body mass index and waist-to-hip ratio: the importance of type of alcoholic beverage

Objective

Alcohol consumption may play a role in the development of obesity but the relationship between alcohol and weight is still unclear. The aim of our study was to assess the cross-sectional association of intakes of total alcohol and of specific alcoholic beverages (wine, beer and spirits) with waist-to-hip ratio (WHR) and body mass index (BMI) in a large sample of adults from all over France.

Design

Cross-sectional.

Setting

Participants were free-living healthy volunteers of the SU.VI.MAX study (an intervention study on the effects of antioxidant supplementation on chronic diseases).

Subjects

For 1481 women aged 35–60 years and 1210 men aged 45–60 years, intakes of total alcohol and specific alcoholic beverages were assessed by six 24-hour dietary records. BMI and WHR were measured during a clinical examination the year after.

Results

A J-shaped relationship was found between total alcohol consumption and WHR in both sexes and between total alcohol consumption and BMI in men only (P < 0.05). The same relationships were observed with wine (P < 0.05); men and women consuming less than 100 g day−1 had a lower BMI (men only) and WHR than non-drinkers or those consuming more. Spirits consumption was positively associated with BMI (linear regression coefficient β = 0.21, 95% confidence interval (CI): 0.09–0.34 and β = 0.22, 95% CI: 0.06–0.39 for men and women, respectively) and WHR (β = 0.003, 95% CI: 0.001–0.005 and β = 0.003, 95%CI: 0.0002–0.006) in both sexes in a linear fashion. No relationship between beer consumption and BMI or WHR was found.

Conclusion

If confirmed in longitudinal studies, our results indicate that consumption of alcoholic beverages may be a risk factor for obesity.

The effect of moderate alcohol consumption on fat distribution and adipocytokines

OBJECTIVE

To investigate the effect of moderate alcohol consumption on fat distribution, adipose tissue secreted proteins (adiponectin and resistin), and insulin sensitivity in healthy middle-aged men with abdominal obesity.

RESEARCH METHODS AND PROCEDURES

Thirty-four healthy men between 35 and 70 years old, with increased waist circumference (> or = 94 cm), participated in a randomized, controlled cross-over design trial. They drank 450 mL of red wine (40 grams of alcohol) or 450 mL of de-alcoholized red wine daily during 4 weeks. At the end of each treatment period, fat distribution, adipose tissue proteins, and insulin sensitivity index (ISI) were measured.

RESULTS

Subcutaneous and abdominal fat contents and body weight did not change after 4 weeks of moderate alcohol consumption. Liver fat (quip index) was slightly higher after consumption of red wine (6.8 +/- 0.1) as compared with de-alcoholized red wine (6.5 +/- 0.1) but not significantly different (p = 0.09). Plasma adiponectin concentration increased (p < 0.01) to 6.0 +/- 0.1 microg/mL after 28 days of moderate alcohol consumption compared with de-alcoholized red wine (5.5 +/- 0.1 microg/mL). Serum resistin concentrations and ISI were not affected by alcohol consumption. Percentage changes in serum resistin correlated significantly with changes in ISI (r = -0.69, p < 0.01), whereas this correlation was not present between changes in plasma adiponectin and ISI (r = 0.31, p = 0.22).

DISCUSSION

Moderate alcohol consumption for 4 weeks is not associated with differences in subcutaneous and abdominal fat contents or body weight. Thus, the 10% increase in adiponectin was not associated with a change in fat distribution or body weight change.

Hipertensão, obesidade abdominal e baixa estatura: aspectos da transição nutricional em uma população favelada

OBJETIVO: Investigar, em mulheres de muito baixa renda, a prevalência e a associação entre a baixa estatura, o sobrepeso, a obesidade abdominal e a hipertensão arterial, discutindo os achados, segundo o processo de transição nutricional e a hipótese da programação fetal (hipótese Barker). MÉTODOS: Foram estudadas 223 mulheres de 18 a 65 anos, por meio dos seguintes indicadores: índice de massa corporal (kg/m²) >25 para sobrepeso + obesidade ou <18,5 para magreza; razão cintura-quadril > 0,8 para obesidade abdominal; pressão arterial sistólica e/ou diastólica >140/90mmHg para hipertensão; percentil 25 (1º quartil) para baixa estatura. RESULTADOS: A prevalência de sobrepeso + obesidade (35,9%) foi superior à de magreza (9,4%). A pressão diastólica associou-se com o índice de massa corporal (r=0,37; IC 95%: 0,01 <r² <0,26) e com a razão cintura-quadril (r=0,35; IC 95%: 0,01 <r² <0,25). Comparando-se os 1º e 4º quartis de estatura, encontraram-se os seguintes resultados, respectivamente, para a prevalência de hipertensão: 23,3% e 8,9% (odds ratio=3,08; p=0,03); para sobrepeso + obesidade: 41,7% e 35,7% (p=0,51); para o índice de massa corporal médio: 24,6 e 23,7 (p=0,27); para a média da razão cintura-quadril: 0,87 e 0,85 (p=0,04). CONCLUSÃO: A prevalência de sobrepeso/obesidade foi menor do que a de desnutrição. A baixa estatura, um indicador de desnutrição no início da vida, foi um importante fator de risco para a hipertensão arterial e para a obesidade abdominal. Apesar da miséria, a população parece estar passando pelo processo de transição nutricional. Os mecanismos resultantes da adaptação metabólica à desnutrição imposta no início da vida, parecem desempenhar importante papel na determinação desses achados.

Nutrição e doenças cardiovasculares: os marcadores de risco em adultos

As doenças cardiovasculares contribuem significativamente, como grupo causal, para a taxa de mortalidade em todas as regiões brasileiras, principalmente na Região Sudeste. Além disso, constituem uma das principais causas de permanência hospitalar prolongada e são responsáveis pela principal alocação de recursos públicos em hospitalizações no Brasil. O ônus econômico das doenças cardiovasculares tem crescido exponencialmente nas últimas décadas. O risco de se desenvolver doença cardiovascular é avaliado com base na análise conjunta de características que aumentam a chance do indivíduo vir a apresentar a doença. O conhecimento desses fatores associados ao risco é de grande importância para o estabelecimento de estratégias de prevenção. Este artigo em questão revisa os principais marcadores de risco para doenças cardiovasculares em adultos, relacionados à nutrição, como os antropométricos, dietéticos e bioquímicos. Além disso, enfatiza o impacto destas morbidades na sociedade, bem como a necessidade de serem estabelecidas medidas de prevenção primária no controle das mesmas.

Waist circumference in relation to history of amount and type of alcohol: results from the Copenhagen City Heart Study

OBJECTIVE

To examine the long-term association between the amount and type of alcohol consumed and subsequent high waist circumference.

DESIGN

Prospective population study with baseline assessment of alcohol intake, body mass index, smoking habit, physical activity, education, income and deliveries, and after 10 y, examination of waist circumference.

SUBJECTS

A sample of 2916 men and 3970 women aged 20-83 y from Copenhagen City Heart Study, Denmark.

MEASUREMENTS

A large waist circumference defined as a waist circumference more than 102 cm in men and 88 cm in women.

RESULTS

The odds ratios of having a high waist circumference after 10 y showed a linear increase in both men and women, and they were 1.65 (95% confidence interval (CI) 1.07-2.55) in men and 2.16 (0.86-5.14) in women who drank more than 28 beverages per week of total alcohol compared to those who drank one to six beverages per week. Men drinking more than 21 beers per week had odds ratio of having a large waist circumference after 10 y of 1.63 (0.99-2.67) and women drinking more than 14 beers per week had odds ratio of 2.53 (0.92-6.34), compared to men and women who drank no beer. Also for spirits, there was an increase in both men and women. No linear trend was found for wine in either men or women.

CONCLUSIONS

Moderate-to-high consumption of alcohol and of beer and spirits was associated with later high waist circumference, whereas moderate-to-high wine consumption may have the opposite effect.

Androgen receptor gene repeats and indices of obesity in older adults

OBJECTIVE

To examine the relationship between GGN and CAG trinucleotide repeat polymorphisms in the androgen receptor (AR) gene and indices of obesity in older Caucasian adults.

DESIGN

A cross-sectional study.

SUBJECTS

Ninety-nine healthy men (age 51-93 y) and 113 healthy postmenopausal women (age 51-92 y).

MEASUREMENTS

Genotyping the GGN and CAG repeats of the AR gene, and measuring body weight, height and waist and hip circumferences. Waist was measured at the umbilicus (wstumb), iliac crest (wstili), and mid-way between the iliac crest and lowest rib (wstwst). Waist-to-hip ratios (WHRUMB, WHRILI and WHRWST) and body mass index (BMI) were calculated.

RESULTS

Women who were homozygous for a common GGN (17 or 18) and short CAG (</=25) had higher waist and hip circumferences and higher WHRUMB and WHRWST, compared with women without this allele combination. The odds ratios (OR) for the upper 25th percentile of obesity measures were 3.6-5.6-fold higher for wstumb, wstwst, WHRUMB and WHRWST among women with this allele combination. Men who had both a rare GGN (not 17) and short CAG (</=23) had a higher WHRUMB and WHRILI compared with men without this allele combination. The OR related to the upper 10th percentile of obesity measures among men who had this allele combination was 4.7-fold higher for WHRILI.

CONCLUSION

AR GGN and CAG allele combinations are strongly associated with central obesity indices in older adults, particularly in women.

Obesity and associated factors in a Palestinian West Bank village population

OBJECTIVE

To describe body mass index (BMI), waist circumference and waist-hip ratio in a Palestinian West Bank village population, and to assess the associations of these variables to blood pressure and serum lipids.

DESIGN

Cross-sectional study.

SETTING

Community-based study in a prototypic semi-rural Palestinian village in the central West Bank.

SUBJECTS

All individuals aged 30-65 y in the study village were invited for the study and 500 (85%) participated.

MAIN OUTCOME MEASURES

BMI > or = 30 was used as the measure of obesity.

RESULTS

The prevalence of obesity was 37.5% among women and 18.8% among men. The prevalence of abdominal obesity was 62.5% among women and 14.8% among men. BMI seemed to be the more important correlate of blood pressure whereas waist-hip ratio seemed to be the more important correlate of serum triglycerides, compared to the other obesity measures.

CONCLUSIONS

The prevalence of obesity in the study population was very high compared to most other countries in the world, particularly among women.

SPONSORSHIP

The study was funded by the Norwegian Universities' Committee for Development Research (NUFU). LCM Stene was supported by a grant from the Throne Holst Foundation.

Body fat distribution in Alaskan Eskimos of the Bering Straits region: the Alaskan Siberia Project

OBJECTIVE

To describe the body fat content and distribution of adult Alaska Natives of the Bering Straits Region.

DESIGN

Cross-sectional screening in the spring of 1994.

SUBJECTS

454 non-pregnant native residents from four rural Alaskan villages.

MEASUREMENTS

Height, weight, waist, hip and thigh circumference, bioelectrical impedance, sagittal abdominal diameter, and triceps, biceps, suprailiac, subscapular and thigh skinfolds.

RESULTS

Mean height, weight and subscapular-to-triceps ratio were higher in men than women. The women had larger waist, hip and thigh circumferences, higher body fatness, as well as larger skinfolds than the men. There were no demonstrable differences between men and women in measures of body fat distribution. The proportions of women and men with high waist-to-hip ratio (>/=0.8 for women, >/=0.9 for men) for low (<25 kg/m2), medium (25-30 kg/m2) and high (>30 kg/m2) body mass index (BMI) groups were compared with a Canadian study of all races. 1 In the lowest BMI subgroup (<25 kg/m2) a much higher proportion of Eskimo women exhibited a high waist-to-hip ratio (91%) than Eskimo men (42%) or Canadian women (29%) or men (51%). In the highest BMI subgroup (>30 kg/m2) Eskimo women were similar in proportion of high waist-to-hip ratio (99%) compared to Eskimo men (100%), but still demonstrated a much greater proportion of subjects with high waist-to-hip ratio than either Canadian men (90%) or women (76%).

CONCLUSIONS

The large abdominal fat depots found in Eskimo women were similar to men, and may indicate that future increases in diabetes mellitus and other metabolic alterations can be anticipated. International Journal of Obesity (2000) 24, 171-179

[Waist:hips girth ratio as a predictor of arterial hypertension]

This study aims to define cut-off points for the waist:hips girth ratio (WHR), using arterial hypertension as the outcome. The data refer to 3,282 individuals over twenty years of age examined in a survey conducted in the municipality of Rio de Janeiro in 1995-1996, using a two-stage sample. Sixty census tracts were drawn initially; subsequently, 34 households were selected systematically from each tract. Stature, weight, waist and hips girths, and blood pressure were measured in the households. The criterion for hypertension was a systolic blood pressure of ( 140 mmHg or diastolic pressure of ( 90 mmHg, or use of medication to reduce blood pressure. The sensitivity and specificity of different cut-off points for WHR were calculated in the prediction of arterial hypertension according to sex, age, and presence of overweight, classified according to World Health Organization guidelines. The best cut-off points for WHR were 0.95 for men and 0.80 for women. Compared to the waist:stature ratio and waist circumference, the WHR proved more capable of predicting arterial hypertension and less correlated with body mass index.

Genetic and behavioral determinants of waist-hip ratio and waist circumference in women twins

OBJECTIVES

This study examines genetic and behavioral determinants of waist-hip ratio (WHR) and waist circumference among women twins.

RESEARCH METHODS AND PROCEDURES

Six hundred eighty participants from the second examination of the Kaiser-Permanente Women Twins Study (1989 to 1990) were included. Women ranged in age from 31 to 90 years, and included 59% monozygotic and 41% dizygotic twins. Heritabilities of WHR and waist circumference were estimated (range=0 to 1) using three different statistical methods. Linear regression models that adjusted for the lack of independence within twin pairs were used to assess associations between behavioral variables, WHR, and waist circumference.

RESULTS

Age and body mass index-adjusted heritability estimates ranged from 0.36 to 0.61 for WHR and 0.72 to 0.82 for waist circumference. When considered individually, after adjusting for age and body mass index, all behavioral characteristics, except calorie-adjusted fat intake, were significantly (p<0. 10) associated with waist circumference and WHR. Greater central adiposity was associated with lower education, higher alcohol consumption, lower physical activity, current cigarette smoking, higher parity, and postmenopausal status without hormone replacement therapy. In multivariate models, these associations persisted, except neither educational attainment nor alcohol intake was significantly associated with waist circumference. In longitudinal analyses, both measures were positively associated with current or recent-past smoking; infrequent or inconsistent physical activity; and long-term, daily consumption of alcohol.

DISCUSSION

These cross-sectional and longitudinal associations are consistent with genetic and behavioral predictors of waist circumference and WHR. Whereas the evidence for genetic influences is stronger for waist circumference, both body fat measures may be similarly influenced by the behavioral factors considered.

Relation of total and beverage-specific alcohol intake to body mass index and waist-to-hip ratio: a study of self-defense officials in Japan

We investigated the independent associations of total and beverage-specific ethanol consumption with body mass index (BMI) and waist-to-hip ratio (WHR) in middle-aged Japanese males, because of the scarcity of epidemiologic data in Japan. The subjects were 2227 male self-defense officials who received a pre-retirement health examination at the Self-Defense Forces Fukuoka, Kumamoto, and Sapporo Hospitals. Data on alcohol intake, smoking, physical activity, and past medical history were obtained from a self-reported questionnaire. Height, weight, and waist and hip girth measurements were obtained at the examination. Multiple linear regression analysis was employed. Alcohol intake was positively and strongly associated with WHR (p = 0.0001), but not associated with BMI after adjustment for lifestyle variables, including either BMI or WHR. Subjects who consumed 15 ml per day or more of shochu ethanol showed a larger WHR than never drinkers, and a dose-response relationship was found. Dose-response relationships to other beverages were not found. Dose-response relationships to other beverages were not found. These findings suggest that alcohol intake is strongly and independently associated with WHR, but not with BMI. Abdominal obesity was positively associated with shochu ethanol, but not with other types of alcohol.

Ovarian aging and hormone replacement therapy. Hormonal levels, symptoms, and attitudes of African-American and white women

OBJECTIVES

To characterize reproductive hormone levels, symptoms, and attitudes related to menopause among healthy, menstruating white and African-American women aged 44 to 49 years.

DESIGN

Pilot study; cross-sectional survey.

SETTING

Community-based convenience sample of women in the Philadelphia metropolitan area.

PARTICIPANTS

Thirty-three African-American and 35 white women.

MEASUREMENTS

The survey instrument collected demographic data, medical and reproductive history, health practices and behaviors. It included previously validated function, depression, and quality-of-life instruments, and a Menopause Attitude Scale that included two factors, attitudes toward the menopause and attitudes toward medical therapy. Anthropometric measurements were taken at enrollment, and reproductive hormones and daily symptom logs were followed over two menstrual cycles.

MAIN RESULTS

The two groups were comparable in mean age (African-American 46.2 years, white 46.9 years). Serum levels of estradiol, follicle-stimulating hormone, dihydroepiandrosterone-sulfate, and progesterone were comparable. Symptoms were similar in type and frequency. However, the African-American women had significantly more positive attitudes toward menopause, were more likely to rely on family for information about menopause, and were less likely to have been recommended hormone replacement therapy by their physicians. A majority of women in each group expressed satisfaction with the care they had received.

CONCLUSIONS

Perimenopausal African-American and white women have different expectations of menopause and the role of medical care in menopause. This bears directly on women's acceptance of hormone replacement therapy. Conclusions are limited by the small sample size and convenience nature of the study population: further work with larger samples is needed to confirm these apparent differences.

Ethnic differences in body composition and their relation to health and disease in women

Differences in body composition between black and white women have been well established. Black women have more bone and muscle mass, but less fat, as a percentage of body weight, than white women, after controlling for ethnic differences in age, body weight, and height. In addition, black women have more upper-body fat than white women. These ethnic differences in body composition appear to be associated with disease risk in women. The greater skeletal and muscle mass in black compared to white women appears to protect them from osteoporosis. The relationship between fat distribution and cardiovascular disease also appears to be influenced by ethnicity. This review has two purposes: (1) To examine previous research investigating ethnic differences in body composition between black and white women; and (2) To demonstrate the relationship between body composition and disease in women as a function of ethnicity.

Education, health behaviors, and the black-white difference in waist-to-hip ratio

Few epidemiologic studies have investigated the impact of body mass index, low educational attainment, cigarette smoking, and physical activity on the considerable black-white difference in waist-to-hip ratio. These relationships were assessed with multivariable linear regression among 3,094 adults (24% black) who were examined in 1987 in South Carolina. The unadjusted mean waist-to-hip ratio was lower for black men than for white men (-0.03 units) and higher for black women than for white women (+0.03 units). After adjustment for age, body mass index, education, smoking, and physical activity, the black-white difference in mean waist-to-hip ratio was -0.02 units (p < 0.001) among men and +0.01 units (p < 0.01) among women. Although differing distributions of age, body mass index, and educational attainment accounted for a 59% reduction in the black-white difference among women, these factors did not explain the difference among men. Thus, these results suggest that other environmental or biologic factors may also play an important role in the marked variation in body fat distribution between the two ethnic groups. The results also support the importance of the prevention of cigarette smoking and overweight in potentially preventing abdominal obesity in both black adults and white adults.

Body mass index in young adults: Associations with parental body size and education in the CARDIA Study

OBJECTIVES

Associations of parental education, parental body size, and offspring's education with body mass index and 7-year change in body mass index were examined among participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study.

METHODS

CARDIA is a study of coronary artery disease risk factors in 5115 Black and White persons aged 18 to 30 at baseline. Analyses of covariance were carried out with body mass index and change in body mass index as the dependent variables, and with parental education, parental body size, and participant education as the major independent variables.

RESULTS

Father's body size was positively associated with participant's baseline body mass index among Black men, White men, and White women. Mother's body size was positively associated with baseline body mass index among all race-sex groups, and with change in body mass index among White women. Father's education was inversely associated with baseline body mass index among Black men and White women, and with change among White women.

CONCLUSIONS

Parental education may influence body mass index and changes in young adulthood, especially among White women. Such associations may be both genetic and environmental and may be important for obesity prevention efforts.

Distribution of anthropometric variables and the prevalence of obesity in populations of west African origin: the International Collaborative Study on Hypertension in Blacks (ICSHIB)

A survey of the prevalence of hypertension and associated risk factors including obesity was carried out among persons of West African heritage currently living in societies at different stages of social, economic and technological development. We present here the distribution of several anthropometric variables and the prevalence of obesity in these populations. Using a standard protocol with centralized training of field staff, 7,439 men and women aged 24 to 75 from six multinational sites were recruited and examined. Although men were taller, women were more obese across sites. Body mass index (BMI) and consequently the prevalence of overweight and obesity increased with westernization from rural African subsistence farming communities to suburban Chicago. Average BMI increased with age until about age 54, and then began to decline or at least level off. The mean BMI for African-American men and women was 27.1kg/m2 and 30.8kg/m2, respectively. Men displayed high levels of centripetal fatness, measured as the waist-to-hip ratio (WHR), compared to the women across site. Based on the US Department of Agriculture guidelines, 22.6% and 56.9% of the African-American men and women had elevated WHR. Although account must be taken of the important contribution of an individual's genetic background, this multinational study of persons with similar heritage clearly shows the potent impact of current environmental factors on the distribution and level of obesity.

Waist-to-hip ratio in a biracial population: measurement, implications, and cautions for using guidelines to define high risk for cardiovascular disease

Cutoff points for high waist-to-hip ratio (WHR) that may define high risk for cardiovascular disease have been suggested for men (0.95) and women (0.80). The WHRs of groups defined by age, race, and sex among 3,118 South Carolina adults were compared with these cutoff points. Measurement methodology, mean WHRs, and prevalence of elevated WHR in this biracial study population were compared with data from other populations. A review of anthropometric measurement methods used in recent epidemiologic studies indicates that a standard method for measuring waist and hip girth is required before comparisons of mean levels can be valid. The paucity of evidence that a high WHR is associated with cardiovascular disease mortality in black populations, and the high number of women who have an elevated WHR in this and other epidemiologic studies, support the following conclusion: Current WHR cutoff points, which are based on evidence from primarily white populations, may not be appropriate for women, older age groups, and some racial or ethnic groups in the United States.